BACKGROUND: Severe cranio-maxillofacial trauma requires the utilization of alternative airway management techniques when oral and nasal routes of tracheal intubation are either not possible or contraindicated.METHODS: This retrospective study evaluated the techniques of submental intubation, retromolar intubation and tracheostomy in terms of their frequency of use, time required, costs involved and associated complications in a total of 200 patients.RESULTS: Frequency of utilization of alternative airway management techniques was 3.63%. Tracheostomy was associated with the most severe complications, took the most time to establish and was the most expensive technique. Although retromolar intubation was not associated with any complications, it was not suitable in adults with erupted third molars and interfered with the surgical field. Submental intubation was associated with minor complications, was suitable in all cases and did not interfere with surgical access.CONCLUSIONS: Retromolar intubation must be considered as a first choice alternative in patients with unerupted third molars provided the surgeon is adept at working in the presence of an oral tube. Submental intubation is a good second choice when retromolar intubation is not possible or is not acceptable to the surgeon. Tracheostomy is only indicated in patients who require long term control of the airway.